1. Introduction
Elder abuse is a phenomenon that has become more apparent with the rapid increase in the number of elderly [1]. According to statistics provided by the World Health Organization, the prevalence of this phenomenon in developed countries varies from 1 to 10% [2]. Gender is an important factor in dealing with abuse. About 10% -15% of older women worldwide are exposed to physical abuse [3, 4]. Considering the different dimensions of elder abuse, it can be stated that many elderly people have been abused by their caregivers and those around them at least once [5]. However, there is insufficient evidence on the prevalence of elder abuse and its gender pattern among the elderly population in Iran. Therefore, this study aims to investigate the prevalence of elder abuse and related patterns based on gender differences in the elderly population in Iran.

2. Methods & Materials 
This descriptive-analytical study was conducted on 414 elderly people aged ≥60 years in Tabriz, Iran who were recruited from health complexes and centers. Inclusion criteria were age ≥60 years, resident of Tabriz city, living in their own home or at the home of a close relative, living with at least one family member, willingness to participate in study and answering questions, and no any cognitive or auditory impairment (full awareness of time, place and person). Two-stage cluster sampling method was used to select samples, where health complexes were as first cluster and health centers as secondary cluster. After random selection of first cluster, two centers from each cluster were randomly selected and in proportion to the population of the health complex, the samples from the health center were randomly selected. After coordination with the Health Organization of Tabriz city and obtaining the necessary permits, were referred to the study centers and the elderly were randomly selected using the SIB system (http://sib.sbmu.ac.ir). After explaining the research process on the phone, if the selected elderly had the conditions to enter the study, s/he was invited to participate in the study; if not, another elderly from the same center was replaced. Data collection tools was a demographic form, and the Domestic Elder Abuse Questionnaire which has 49 items and 8 subscales. They were completed through interview and the collected data were then analyzed in SPSS V. 22 software.

3. Results
A total of 414 elderly people (261 females and 153 males) aged 60-98 years (mean age= 67±7.09) participated in this study. The majority of participants were married (73%) and had their own houses (92%). 52.6% of participants reported abuse. The most common type of abuse was emotional neglect by family members; i.e. less visiting and calling them (26.8%) or ignoring and not talking to them (26.6%). Financial abuse (17.6%) was in the second place. Physical abuse was the least common abuse. The results showed that, except for the financial abuse, older women were more abused than older men (Table 1).

Participants complained that family members do not return the money they borrowed from them. In some cases, yelling at the elderly (15.5%) and blaming them for no reason (14.5%) by family members were reported as psychological abuse.
Another important result of this study was the level of understanding of elder abuse and how to deal with it. For this purpose, three new questions were added to the end of the Domestic Elder Abuse Questionnaire, and those who were abused even with a positive answer were asked to answer “yes” or “no” to these questions. Out of 218 elderly people who were abused, only 69 (31.7%) considered the mentioned abuses as elder abuse; 131 (60.1%) of the abused elderly informed others about their problems. A high percentage (91.7%) of the elderly were satisfied with their family members despite being abused.

4. Conclusion
Despite the importance of treating elders with respect, the elderly in Tabriz experience elder abuse in the family, which can be due to rapidly changing values, attitudes, behavioral patterns and moral standards in the family. They mostly experience financial abuse and neglect and perceived many instances of elder abuse to be normal behavior of family members. Furthermore, older women are more likely to be abused than males. It is necessary to take the necessary measures to inform families about the physical, psychological, emotional and social needs of the elderly, change negative attitudes towards the aging period, and attracting the attention of the country’s health care system to increase respect for the elderly.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by Ethics Committee of Tabriz University of Medical Sciences (Code: IR.TBZMED.REC.1398.191). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.

Funding
This study was extracted from the Msc. thesis of first author at Department of Health Education & Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz. Also, this study was supported by Saba Pension Strategies Institute.
 
Authors' contributions
Conceptualization: Habibeh Seutodan Hagh, Hassan Rezaeipandari, Hamid Allahverdipour; Methodology: Habibeh Seutodan Hagh, Hassan Rezaeipandari, Hamid Allahverdipour, Saeed Mousavi; Data analysis: Hassan Rezaeipandari, Hamid Allahverdipour, Saeed Mousavi; Writing of original draft and editing: Habibeh Seutodan Hagh, Hassan Rezaeipandari, Hamid Allahverdipour; Final approval: All authors.
Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
The authors would like to thank Saba Pension Strategic Institute (SABA) for financial support. The authors also appreciate the assistance of the Health Center of Tabriz City.

References